Xi Siyu, Zhang Haishan, Gao Yuan, Chen Xin, Tan Wenfei, Guo Liang, Sun Yingxian
Department of Cardiology, The First Hospital of China Medical University, Shenyang, China.
Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China.
Cardiovasc Diagn Ther. 2023 Jun 30;13(3):487-495. doi: 10.21037/cdt-22-565. Epub 2023 May 10.
Previous studies have shown that neo-commissural orientation of transcatheter heart valve (THV) can influence coronary obstruction during transcatheter aortic valve replacement (TAVR), long-term durability of THV, and coronary artery access for reintervention after TAVR. Specific initial orientations of Evolut R/Pro and Acurate Neo aortic valves can improve commissural alignment. However, the method of achieving commissural alignment with the Venus-A valve remains unknown. Therefore, this study aimed to evaluate the extent of commissural and coronary alignment of the Venus-A self-expanding valve after TAVR using a standard system delivery technique.
A retrospective cross-sectional study was performed. At the time of enrollment, patients who underwent pre- and post-procedural electrocardiographically-gated contrast-enhanced CT with a second-generation 64-row multidetector scanner were selected for the study. Commissural alignment was categorized as aligned (0-15° angle deviation), mild (15-30°), moderate (30-45°), or severe (45-60°) commissural misalignment (CMA). Coronary alignment was categorized as having no coronary overlap (CO) (>35°), moderate CO (20-35°), or severe CO (≤20°). The results were represented as proportions to assess the extent of commissural and coronary alignment.
Forty-five TAVR patients were ultimately included in the analysis. THVs were shown to be randomly implanted: 20.0% of THVs were aligned, 33.3% had mild CMA, 26.7% had moderate CMA, and 20.0% had severe CMA. The incidence of severe CO was 24.4% with the left main coronary artery, 28.9% with the right coronary artery, 6.7% with both coronary arteries, and 46.7% with one or both coronary arteries.
The results showed that commissural or coronary alignment could not be achieved with the Venus-A valve using a standard system delivery technique. Therefore, specific methods to attain alignment with the Venus-A valve need to be identified.
先前的研究表明，经导管心脏瓣膜（THV）的新连合线方向可影响经导管主动脉瓣置换术（TAVR）期间的冠状动脉阻塞、THV的长期耐用性以及TAVR后再次干预的冠状动脉通路。Evolut R/Pro和Acurate Neo主动脉瓣的特定初始方向可改善连合线对齐。然而，使用Venus-A瓣膜实现连合线对齐的方法仍不明确。因此，本研究旨在使用标准系统输送技术评估TAVR后Venus-A自膨胀瓣膜的连合线和冠状动脉对齐程度。
进行了一项回顾性横断面研究。在入组时，选择接受了术前和术后心电图门控对比增强CT检查的患者，使用第二代64排多层探测器扫描仪进行研究。连合线对齐分为对齐（角度偏差0-15°）、轻度（15-30°）、中度（30-45°）或重度（45-60°）连合线错位（CMA）。冠状动脉对齐分为无冠状动脉重叠（CO）（>35°）、中度CO（20-35°）或重度CO（≤20°）。结果以比例表示，以评估连合线和冠状动脉对齐程度。
最终45例TAVR患者纳入分析。THV显示为随机植入：20.0%的THV对齐，33.3%有轻度CMA, 26.7%有中度CMA，20.0%有重度CMA。左冠状动脉重度CO的发生率为24.4%，右冠状动脉为28.9%，两支冠状动脉均为6.7%，一支或两支冠状动脉为46.7%。
结果表明，使用标准系统输送技术，Venus-A瓣膜无法实现连合线或冠状动脉对齐。因此，需要确定与Venus-A瓣膜实现对齐的具体方法。
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